Carolyn Wyler

Expecting the unexpected

It’s practically a no-brainer in the medical field — something ingrained in our nursing and medical school training for years. “Be prepared,” (oh wait, that’s the Boy Scout motto, one that I knew, not because anyone would let me in the Boy Scouts, but because I had four brothers who were scouts), pay attention, be aware of changes and always expect what might and could happen in a worst case scenario. To expect that everything will always go perfectly, without a hitch, is a fool’s dream and those fools who are unprepared are often caught off guard.

I work in a cardiology and nephrology clinic and we are constantly telling our patients “we are not a walk in-urgent care or an emergency room. If you need immediate medical attention, do not come in,unannounced, to our clinic.” You will die. Well okay, we don’t usually add that last part, but we try to stress that we aren’t set up with all the necessary equipment to handle real urgent emergency situations We are always still prepared, just in case there’s that one “dummy” who drops into our clinic unannounced, looking for emergency care.

Her name was April and I can honestly say she was the worst looking patient we ever had in our clinic. (I am not violating any HIPAA rules as I have a disclaimer, which you can see at the end of the column, but do not look there now until you have first read this story in its entirety). Her left side of her face was partially peeled off, exposing red muscle. Although perhaps it should have, it didn’t really seem strange to me that she wasn’t bleeding nor was she complaining of any pain. It really hurt me, though, to look at her. She seemed perfectly calm (albeit a bit angry), as if walking around with only half a face was quite normal. I sat her down in a chair and attempted to do an assessment.

She was quite an odd looking lady even if her face had been all there. Her eye balls seemed a bit sunken into her sockets and the whole time I was in the room with her, she never seemed to blink. The good side of her face showed multiple wrinkles and she looked way older than her birth date of 4/1/41, which meant that today was her birthday. (Not particularly how I would want to celebrate my birthday, hanging out at a doctors office). She had really long straight blond hair (not a gray hair in it, must be dyed), which went past her hips. She wore a coconut bra on the outside of her clothes, though I don’t think even that held much up. Her head and distended abdomen were much larger than her skinny, scrawny legs and feet, which sported brightly colored leggings and pink, yellow, blue and green shoes, which glowed in the dark when the lights turned out.

I quickly jotted down everything I could about her condition and why she was here. I had only my own objective assessment to go on. I obtained an EKG, not that she said anything about chest pain, but because we were a cardiology clinic and that is what we do. I was going to discuss her with one of the cardiologists who had his own full schedule that day, but I knew wouldn’t be too upset about taking a look at Mrs Fullz. Her last name was Fullz, I assumed because she had a sign in her brightly yellow neon gloved hands that stated her full name and birthdate. I couldn’t determine by her last name what nationality she was, nor was she speaking, so I couldn’t provide her with an interpreter. I had only my own objective assessment to go on.

I gathered up all my data on the patient and went in to talk to the doctor. He was obviously a little perturbed that there was another patient added on to his schedule without his knowledge and questioned me as to why we didn’t send her directly to the ER. I was aware of the standard protocol in which we were to call 911 if any patient needed any emergency treatment, but this was not your average patient. I really felt he should see her as soon as possible, as I knew transporting her to the ER was not what most ambulances would be willing to do. He spent several minutes trying to look her up by her last name Fullz, April and date of birth of 04/01/41 and asked me for her medical record number as he could not find her. I knew she didn’t have a medical record number as she had never been seen in our hospital before. I began to get a little anxious, knowing he was getting a little frustrated and neither he nor I really had the time for this nonsense. I showed him the EKG of an ST elevation, indicative of a myocardial infarction (heart attack) and I pleaded with him one last time just to come in and see the patient as she really looked awful. Slightly annoyed he followed me into the small office where there he found Mrs Fullz sitting in a chair staring straight ahead.

The doctor laughed loudly. A patient in another exam room come out to see what was all the commotion was as by this time lot of the staff was clustered around the exam room laughing as well. Let me just add here, in case you think my co-workers and I are extremely insensitive, the odd old patient whose name was April Fullz was an actual dummy. I had created her at home to prank one of the doctors and it was a big success.

Happy April Fools Day, everyone, and on this day especially, expect the unexpected.

(Unfortunately I am not at work this year to play my annual pranks and will have to save my next April Fools joke for next year.)